394例小儿可触及隐睾的腹腔镜治疗体会

Laparoscopic Treatment Experience with 394 Cases of Palpable Cryptorchidism in Children

目的:探讨腹腔镜在小儿可触及隐睾手术中的应用价值。方法:分析了2012年1月至2020年6月,我院小儿外科收治的394例隐睾患儿,分别施行腹腔镜睾丸下降固定术;腹腔镜结扎鞘状突,直接于阴囊取切口行睾丸下降固定术;腹腔镜打开同侧鞘状突,将睾丸拉入腹腔分离,再行睾丸下降固定术。结果:394例可触及隐睾患儿中双侧隐睾有113例(28.7%),右侧隐睾有160例(40.6%),左侧隐睾有121例(30.7%)。其中有325例存在一侧或双侧鞘状突未闭,均在术中同时行腹腔镜下鞘状突高位结扎术。另有6例患儿,术中发现同侧鞘状突已闭合,但睾丸位于腹股沟中段,遂于腹腔镜下打开鞘状突,将睾丸拉入腹腔分离后行睾丸下降固定术。394例患儿均能Ⅰ期将睾丸下降及固定于阴囊,术后均不存在腹股沟区切口。结论:腹腔镜下治疗小儿可触及隐睾,可以更彻底地分离精索血管及输精管,创伤小,手术效果好,术后美观,在临床中值得推广。

Objective:The present study was performed to investigate the clinical application value of laparoscopy in children with palpable cryptorchidism.Methods:The subjects of study were 394 children with cryptorchidism who were treated from January 2012 to June 2020,including 384 cases with palpable testis preoperatively,and 10 cases of faintly palpable testis.According to the location of the testis,laparoscopic orchidopexy,laparoscopic ligation of the processus vaginalis with direct incision in the scrotum for orchidopexy,and laparoscopic opening of ipsilateral processus vaginalis to pull the testis into the abdominal cavity for separation and then orchidopexy were performed respectively.Results:Of the 394 children with palpable cryptorchidism,113 cases(28.7%)had bilateral cryptorchidism,160 cases(40.6%)had right cryptorchidism and 121cases(30.7%)had left cryptorchidism.Furthermore,325cases of 394children had unilateral or bilateral patent processus vaginalis and underwent laparoscopic high ligation of the processus vaginalis.Another 6 cases were found with closed ipsilateral processus vaginalis of cryptorchidism,yet showing the location of testis in the middle inguinal segment.Accordingly,the processus vaginalis was opened under laparoscopy,and the testis was pulled into the abdominal cavity for separation,followed by orchidopexy.All the 394 cases were able to obtain successful orchidopexy with the testis fixed in scrotum in phase I.Besides,there was no presence of inguinal incision after operation.Conclusion:Laparoscopic treatment of children with palpable cryptorchidism can separate spermatic vessels and spermatic duct more thoroughly,with less trauma intraoperatively.Besides,it can repair ipsilateral or even contralateral patent processus vaginalis simultaneously,with beautiful postoperative appearance,which is worthy of promotion in clinic.